Programme Officer, Psychological First Aid
Icelandic Red Cross
103 Reykjavik, Iceland
Tel.: + 354 570 4000
Fax: + 354 570 4010
An island democracy in the North Atlantic, Iceland has a population of approximately 280,000 inhabitants, most of whom live in the capital, Reykjavik. The people of Iceland generally benefit from a high standard of living.
The island is geologically young and both volcanic eruptions and earthquakes are quite common. During the long, harsh winters, avalanches are frequent.
Two major earthquakes, measuring 6.5 on the Richter scale, struck Rangárvallasýsla county on 17 and 20 June 1999. Scientists had been expecting major quakes in the southern part of the island as seismic tension had been building up over the last 100 years; not all the tension was released in the 1999 earthquakes, however, so further quakes are anticipated within the next 20 years. The inhabitants of Iceland are therefore prepared for earthquakes to hit their island and building regulations require that all constructions be built to withstand them.
Although disasters in Iceland generally result in a small number of victims with physical injuries, the Icelandic Red Cross (IRC) realized that far greater numbers of people suffered from the psychological distress caused by disaster. The IRC therefore decided to offer psychological first aid (PFA) and psychological support (PS) to disaster victims. A working group of psychological first aid instructors was formed to give courses in PFA/PS around the country.
To offer effective PFA/PS to victims of disaster in Iceland.
To train a sufficient number of PFA instructors who can then instruct volunteers throughout Iceland.
Brief description of activities
In addition to the group of PFA instructors, the IRC set up in 1999 a cross-professional, volunteer psychological support team of 25 experts. Experienced psychologists, priests, nurses and other professionals, all of whom have worked with children and teenagers, make up the team.
The team's primary objective was to give psychological support to children and teenagers. Although they work primarily with this age group, they may be asked by IRC to assist in other PFA/PS activities. The team is managed by the IRC's psychological first aid programme officer.
Main elements of the programme
The IRC's PFA/PS team was very active in the aftermath of the June 1999 earthquakes which hit Rangárvallasýsla county (about 100 km east of Reykjavik). Rangárvallasýsla is an area of farms and small villages with some 3,200 inhabitants. A total of 250 homes were damaged, of which 18 were totally destroyed, and a few people suffered minor physical injuries.
Rangárvallasýsla's civil defence asked the IRC to provide PFA support. The day after the first tremor, 18 June, the PFA team was in place and an initial assessment of the situation was made in cooperation with the local authorities. It was decided to set up a Red Cross care shelter in the local school in the village of Hella and the PS team and PFA instructors began work immediately. Most psychological support for victims was carried out from 18 to 27 June, during which period team members worked, on average, for half a day each, although many worked for much longer periods.
The care shelter stayed open from early in the morning until late at night to support traumatized inhabitants. When the second earthquake struck during the night of 20 June, the shelter opened immediately to deal with the crowds of people in need of PFA.
Various services were provided, at first in Hella and a little later in other towns and rural areas. Educational meetings were set up, booklets distributed, debriefings held and care and guidance provided for individuals and families. The IRC's PFA programme officer and the local priest held meetings for the local population and for people who work with children and teenagers, explaining what are normal reactions to abnormal situations.
Debriefing and educational sessions were also held for the children, again with the local priest participating. The children later distributed IRC booklets about trauma and psychological first aid to every house in their villages.
It was important in all of these meetings to work closely with the local priest, who knew the villagers and their children personally. It was evident from the reactions of the local inhabitants that they appreciated the participation of someone they knew.
The IRC also held special meetings, in their own language, to inform and support immigrants living in the area, mainly Chileans and Poles. It is especially important to be proactive in reaching out to minority groups, as they may not seek help on their own.
In all, about 100 formal sessions on care and guidance were given to 162 people and several were held over the phone. Some 120 people took part in debriefings and 690 attended local educational meetings. Further support was given to those in need of more than psychological first aid. IRC also organized debriefings for PFA/PS volunteers with psychologists who are not part of the IRC's team.
In Iceland, most psychological services are situated in and around Reykjavík. After the earthquakes, the IRC felt it would be useful to offer follow-up services in the affected area. One of the psychologists who was part of the emergency operations now holds weekly sessions at the Hella medical clinic. Although people were at first a little ill at ease, their reluctance has gradually diminished and many now use the service.
The public's awareness of the services offered by the PFA/PS teams increased enormously after the earthquakes, and the team has since received a number of requests for assistance, for example after accidents.
Monitoring and evaluation
IRC's psychological support and psychological first aid programmes are still "under construction". It was therefore considered important to evaluate what the beneficiaries thought of the earthquake operation. A survey was carried out two months after the events and 83.3 per cent of the people to whom questionnaires were sent replied.
The vast majority of the participants (88 per cent) agreed with the IRC being involved in disaster recovery and were satisfied with its assistance in general during and after the earthquakes. Another 97 per cent said that the assistance offered by the Red Cross did them good (3 per cent said it did not make a difference).
The survey also aimed at measuring the degree of possible psychological distress people suffered from after the earthquakes. To evaluate coping styles (intrusive and avoidance thoughts), questions from the Impact of Event Scale questionnaire developed by Horowitz et al.(1979) was used. Intrusions include unwelcome thoughts and images and troubled dreams. Avoidance responses include constricted ideas, denial of meanings and consequences of the event.
People were asked if they had felt any psychological distress after the earthquakes. The results showed that 72 per cent of the people who participated in the survey had intrusive thoughts about the earthquakes (i.e., dreams about them). Only 29 per cent of the participants had avoidance thoughts about the earthquakes. In both cases, the percentage of women replying positively to the questions was significantly higher than men.
As rapid a response as possible to an event makes it easier to reach people and helps them feel at ease with the whole PFA/PS process. In the case of the earthquakes, the teams were present the day after the first earthquake and immediately set up meetings, distributed booklets, held debriefings, provided care and guidance for individuals and families and, if necessary, provided follow-up support.
There was a close and continuous cooperation between the IRC, the local authorities and beneficiaries. This helped to build a bridge of trust and improved efficiency.
It proved to be of great importance that the PFA programme officer was on the spot and able to assess the situation continuously and, at the same time, to keep in contact with headquarters in Reykjavík and get feedback and back up from them.
Also extremely important was the excellent cooperation with the local priest, who participated actively in the process, and with the numerous local IRC volunteers who gave their time and effort. This collaboration will be very useful for future activities in the region.
The survey of the operations confirmed the need for a long-term commitment to psychological support. The survey also showed that women constitute a vulnerable group in the aftermath of disaster.